Getting beyond the head lice ‘Ick factor’

Pediatricians urge schools to lighten up on strict policies regarding the ectoparasite

With the school year having started, one subject likely to be on the minds of parents – but not on the heads of their children, they hope – is head lice, those much-dreaded ectoparasites whose appearance commonly provokes alarm, even panic, among adults.

The American Academy of Pediatrics thinks such fear is hugely overblown. (Way bigger than the actual insects, which are typically no longer than the thickness of a nickel.) In its new, updated guidelines for treating lice infestations, the AAP again urges schools to abandon strict policies of requiring children to be free of nits (louse egg casings) before they can return to school. The bugs, they say, aren’t reason enough to miss class.

We asked Dr. Howard Taras, a professor of pediatrics at the University of California San Diego and community alliance director for UCSD’s Clinical & Translational Research Institute, to examine the issue.

Q: Are head lice overrated as a health threat?

A: Most doctors chuckle and roll their eyes about talk of head lice as a “health threat.” These lice are not a disease and they do not lead to disease. The most important reason to take head lice seriously is the “ick factor,” which is ever-present among parents and teachers. Schools’ public relations woes – as well as the time and anxiety expended by non-health professionals on head lice concerns – are reasons enough to take these bugs seriously.

Q: How contagious are they?

A: They are very contagious when one child has multiple live head lice and has head-to-head contact with another child. They are not very contagious through objects – for example, pillow cases, carpets or seat cushions – because the louse does not live long outside of the hair shaft.

And as lice cannot jump or fly, close proximity to someone with head lice is not risky. I personally have examined and found live head lice on about a hundred children over my years as a pediatrician and yet I’ve never “caught” head lice myself from this intimate interaction. Any itchiness or creepy-crawly feeling I’ve felt afterward has been purely psychological.

Q: Do you agree with the AAP’s new position that no healthy child should be excluded from school because of head lice, so long as the child receives appropriate treatment?

A: Absolutely. If a child in school is found to have head lice, his or her parents should be alerted to treat that evening. Removing nits can be so tedious and difficult that this should not be a requirement for re-entry to school.

Q: What is appropriate treatment? How well does it work? Are there common mistakes?

A: There are many appropriate treatments, and parents can follow school instruction sheets or follow the instructions of their child’s own doctor. Permethrin 1% (“Nix”) or Pyrethrins (“RID,” “A-200,” “R&C,” “Pronto” and “Clearlice”) are good treatments. When done properly, one of these “pediculicides” will likely be the only treatment a child will need.

Mistakes in application are incredibly common. For Permethrin, parents often forget to shampoo their child’s hair first or they fail to have the child’s hair just slightly damp. Another mistake is that parents do shampoo their child’s hair first, but they use a conditioner shampoo. Hair conditioners decrease the effectiveness of the pediculicide. For Pyrethrin-based pediculicides, parents fail to realize that these products need to be applied to dry hair.